FORM 1023-EZ for SAFE AT PLAY INC

Field Data
EIN 81-2357547
Case Number EO-2016116-000456
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SAFE AT PLAY INC
Organization’s Mailing Address 300 GLEN ECHO DRIVE
City COVINGTON
State GA
ZIP 30016-7408
Accounting period End 3
Primary contact name LATANYA DEBRUHL - AUTHORIZED REP
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LATANYA DEBRUHL
PRESIDENT / TREASURER
300 GLEN ECHO DRIVE
COVINGTON GA 30016-7408

Officer/Director/Trustee Two

LEE DEBRUHL
VICE PRESIDENT
300 GLEN ECHO DRIVE
COVINGTON GA 30016-7408

Officer/Director/Trustee Three

PATRICIA RICHARDSON
SECRETARY
3443 SALEM COVE TRAIL SE
CONYERS GA 30013-5320

Officer/Director/Trustee Four

CYNTHIA SINGLETON
MEMBER AT LARGE
3443 SALEM COVE TRAIL SE
CONYERS GA 30013-5320

Officer/Director/Trustee Five

JAMIE DEBRUHL
MEMBER AT LARGE
9 LINK ROAD
LEXINGTON VA 24450-2203

Organization’s website WWW.SAFEATPLAY.ORG
Organization’s email INFO@SAFEATPLAY.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/12/2016
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M40 - Safety Education
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
Scientific: Yes
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence Yes
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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